HOW does Dr. oversite of NP work....

[Dr.MISHKA D.O.]

Just a question, I have been given the option of giving oversite to NP's at urgent care centers. The centers will be owned by the Hospital I will be working at as an ED Doc. Will this create any real revenue for me, or is this just more responsibility for no money. Any thoughts appreciated.

Thanks

The Mish

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[rad_one]

You're going to sign your name to chart on a patient (who you never saw) seen by some nurse? I 've seen docs get sued when things get screwed up.
I wouldn't stick my neck out for that crap.

 

[sistermike]

You're going to sign your name to chart on a patient (who you never saw) seen by some nurse? I 've seen docs get sued when things get screwed up.
I wouldn't stick my neck out for that crap.

First off, get your head out of your ass (excuse my language and forward attitude). "...seen by some nurse?..." -- This "some nurse" is a nurse practitioner whom probably knows JUST AS MUCH as a primary care doc. If you don't think so, then you have some research to do. Most NP's I run into are far more advanced (knowledge wise) than a doctor. Most NP's have years of experience as an RN, and because of that, their observation skills are usually much more keen; therefore, as a NP in any sort of environment, they usually do much better than a doctor. You mention that you have seen doctors get sued "when things screw up." Do you have any credible research that proves that NP's cause a higher % of lawsuites for their attending MD/DO? I HIGHLY DOUBT IT. Excuse my explosive attitude, but it angers me when doctors stick on their high horse and pretend to be know it all's. Perhaps you should stop and pay attention to what the nurses do for you. If it weren't for the nurses, you would be nothing.

To the original poster - I think being the attending over NP's would be an awesome experience (very educational as well). You will probably soon find out how awesome it is to work with NP's. Their attitudes and personalities tend to be bubbly and excited to work. Their isn't a huge malpractice risk, as the other poster suggested.

 

[50960]

Yes that post was rude and ignorant, however NP's are not even close to MD's in training. Does evey provider have to be an MD, of course not. I actually prefer to see NP's myself if I need medical care in primary care as they spend more time, and have a more holistic view of medical care. If I need advanced medical intervention I want an MD specialist, because their training is years longer and much more intense than a midlevel provider. FYI, I am a medical psychologist and work with PA, NP and MD/DO' daily. I have alot of respect for midlevels, and I hope nothing I have said here detracts from that, but they are not equal to MDs.

 

[sistermike]

Yes that post was rude and ignorant, however NP's are not even close to MD's in training. Does evey provider have to be an MD, of course not. I actually prefer to see NP's myself if I need medical care in primary care as they spend more time, and have a more holistic view of medical care. If I need advanced medical intervention I want an MD specialist, because their training is years longer and much more intense than a midlevel provider. FYI, I am a medical psychologist and work with PA, NP and MD/DO' daily. I have alot of respect for midlevels, and I hope nothing I have said here detracts from that, but they are not equal to MDs.

I never implied they were equal to MD's. Although my response was ignorant and rude, it was just up the alley of the poster who was ignorant toward the field of NP's. I must say it bothers me when people make uneducated guesses concerning the nursing field.

 

[PublicHealth]

Just a question, I have been given the option of giving oversite to NP's at urgent care centers. The centers will be owned by the Hospital I will be working at as an ED Doc. Will this create any real revenue for me, or is this just more responsibility for no money. Any thoughts appreciated.

Thanks

The Mish

For starters, NPs will correct MD/DO's incorrect spelling of "oversight."

 

[MacGyver]

For starters, NPs will correct MD/DO's incorrect spelling of "oversight."

Yes they call it "collaboration" instead.

However, thats just BS spin. If NPs and MDs were truly equal partners worthy of "collaborative" status, then explain to me why NPs have to "collaborate" yet MDs can get away with no collaboration at all.

 

[group_theory]

The amount of oversight or collaboration requirement for an NP is dependant on individual states and their respective nursing board.

In terms of malpractice, lawyers go where the money is. If the NP has the same coverage (malpractice insurance) as his/her supervising/collaborating physician - the lawyer will go after BOTH because then he/she can hope for a double-payout from both. If the physician has a $1 million/$3 million coverage and the NP has something smaller, then the lawyer will go after the physician simply because that's where the money is (and strategy on how to pursue such lawsuits will be based on who has what money, not necessarily on the truth and who was truly responsible). Sometimes if both the physician and NP have too little coverage, the laywer will go after the hospital/group practice instead.

It has nothing to do with who is better trained, or who is supervising whom, or whether someone is an MD, an NP, a PA-C, a MS3, a LPN/RN doing stuff under the MD orders, etc, or who was truly at fault (if any) ... it's who can give the plantiff and his/her lawyer the most money.

ex-lawyers and lawyers SDNers, please chime in and say I'm wrong and restore my faith in the our judicial system

 

[Happy613]

I know that PA's have to have their collaborating physician review something like 10% of the charts; however if a malpractice claim is brought by a patient against a PA, and it was not on one of those "10% reviewed" is the MD/DO still liable?

 

[Happy613]

The biggest problem with using NP's is that its hard for most physicians to figure out their credentialing. With PA's, at least today, physicians are really familiar with thier course of study and clinical experience. With NP's it seems to be less standardized.

When I have my own practice, If I choose to hire midlevels I could really see going the PA route, only b/c I have trained with PA students and know exactly what their training is.

This is far from Ideal b/c I am missing out on some potentially phenomenal NP's. The crux is that I have confidence that PA's, by virtue of thier degree and licencsing, have a certian level of competence that I can be sure of. I can't seem to find a correlate with regard to NP training. I am not saying that NP training is sub-par, I have been taught by many excellent NP's on the floors and highly respect them. But since there are so many routes to an NP, how can I tell the seasoned ICU NP from the RN with an online course?

 

[Jengirl18]

Thanks Happy for being PA-friendly

 

[DNP student]

Just a question, I have been given the option of giving oversite to NP's at urgent care centers. The centers will be owned by the Hospital I will be working at as an ED Doc. Will this create any real revenue for me, or is this just more responsibility for no money. Any thoughts appreciated.

Thanks

The Mish

The best answer to your question is to check the Nurse Practice Act for your state. Also, talk to hospital admin. Here in GA, the MD and NP working in a hospital-owed urgent care facility are both paid by the hospital So, no matter how many patients you see, you will still get the same pay. Depending on your state, the NP can sign his/her own charts and write scripts. You are available for consult for anything that is out of the scope of the NP. Most NP's I know are VERY conscious of what's outside the scope. You see, if somthing happens, the NP is just as liable (if not more) than the MD/DO. The main difference is that the NP is much more likely to lose his/her license (RN license that is, not just NP certification). His/her career could be completely over.

Yes, there are some NP's that are basically brain-dead; just like some MD/DO's are basically brain-dead. It makes me nuts when people generalize because of something they heard about.

 

[WannabeOrtho]

First off, get your head out of your ass (excuse my language and forward attitude). "...seen by some nurse?..." -- This "some nurse" is a nurse practitioner whom probably knows JUST AS MUCH as a primary care doc. If you don't think so, then you have some research to do. Most NP's I run into are far more advanced (knowledge wise) than a doctor. Most NP's have years of experience as an RN, and because of that, their observation skills are usually much more keen; therefore, as a NP in any sort of environment, they usually do much better than a doctor. You mention that you have seen doctors get sued "when things screw up." Do you have any credible research that proves that NP's cause a higher % of lawsuites for their attending MD/DO? I HIGHLY DOUBT IT. Excuse my explosive attitude, but it angers me when doctors stick on their high horse and pretend to be know it all's. Perhaps you should stop and pay attention to what the nurses do for you. If it weren't for the nurses, you would be nothing.

To the original poster - I think being the attending over NP's would be an awesome experience (very educational as well). You will probably soon find out how awesome it is to work with NP's. Their attitudes and personalities tend to be bubbly and excited to work. Their isn't a huge malpractice risk, as the other poster suggested.

Are you a nurse? LOL. Why are you so bitter?

 

[zenman]

ex-lawyers and lawyers SDNers, please chime in and say I'm wrong and restore my faith in the our judicial system

That will never happen

 

[DNP student]

The amount of oversight or collaboration requirement for an NP is dependant on individual states and their respective nursing board.

In terms of malpractice, lawyers go where the money is. If the NP has the same coverage (malpractice insurance) as his/her supervising/collaborating physician - the lawyer will go after BOTH because then he/she can hope for a double-payout from both. If the physician has a $1 million/$3 million coverage and the NP has something smaller, then the lawyer will go after the physician simply because that's where the money is (and strategy on how to pursue such lawsuits will be based on who has what money, not necessarily on the truth and who was truly responsible). Sometimes if both the physician and NP have too little coverage, the laywer will go after the hospital/group practice instead.

ex-lawyers and lawyers SDNers, please chime in and say I'm wrong and restore my faith in the our judicial system

Actually, in GA and AL, insurance coverage is not known until after the defendants are named in the suit. I believe it is a violation of privacy to delve into someone's malpractice insurance before the defendants are nnamed. However, some defendants are dropped because they don't have enough insurance.

 

[oldManDO2009]

First off, get your head out of your ass (excuse my language and forward attitude). "...seen by some nurse?..." -- This "some nurse" is a nurse practitioner whom probably knows JUST AS MUCH as a primary care doc. If you don't think so, then you have some research to do. Most NP's I run into are far more advanced (knowledge wise) than a doctor. Most NP's have years of experience as an RN, and because of that, their observation skills are usually much more keen; therefore, as a NP in any sort of environment, they usually do much better than a doctor. You mention that you have seen doctors get sued "when things screw up." Do you have any credible research that proves that NP's cause a higher % of lawsuites for their attending MD/DO? I HIGHLY DOUBT IT. Excuse my explosive attitude, but it angers me when doctors stick on their high horse and pretend to be know it all's. Perhaps you should stop and pay attention to what the nurses do for you. If it weren't for the nurses, you would be nothing.

To the original poster - I think being the attending over NP's would be an awesome experience (very educational as well). You will probably soon find out how awesome it is to work with NP's. Their attitudes and personalities tend to be bubbly and excited to work. Their isn't a huge malpractice risk, as the other poster suggested.

Do you have any proof NP's are more experienced and know more than a primary care doctor. I would like to see a group of NP's sit for step one or two (you pick) and THAN maybe your statement might have some truth!!!

I find it contemptuous that you could equivocate 7 years of training to 2 years of graduate school courses that (in most cases) include a year of "pharmacology" and "path-physiology" and that is equivalent to 2 years of mind numbing science and at lest 5 more years of clinical training- get real. I am a nurse in med-school and unless you are doctor you do not even know what you are talking about.

edit.....

As for PA's - I train with them and I agree with Happy - you know what you are getting.

I worked with a nurse that took most of her courses via the internet and set up her own clinical hours. I do not see a lot of standardization in that...

Finally, I worked with some great mid-levels in my last job (NP & PA) and they were great providers. They also knew the limits to their scope of practice just as I will when I graduate. I will not go around comparing myself to a neurosurgeon (hopeful EM doc)....

 

[megsMS]

Right on! I'm so glad that someone else has a brain on here. I agree with everything you said and the truth is that I think that you have more of a right to say it than anyone else b/c you can see it from the perspective of a nurse and an M.D.! Good for you.

Do you have any proof NP's are more experienced and know more than a primary care doctor. I would like to see a group of NP's sit for step one or two (you pick) and THAN maybe your statement might have some truth!!!

I find it contemptuous that you could equivocate 7 years of training to 2 years of graduate school courses that (in most cases) include a year of "pharmacology" and "path-physiology" and that is equivalent to 2 years of mind numbing science and at lest 5 more years of clinical training- get real. I am a nurse in med-school and unless you are doctor you do not even know what you are talking about.

edit.....

As for PA's - I train with them and I agree with Happy - you know what you are getting.

I worked with a nurse that took most of her courses via the internet and set up her own clinical hours. I do not see a lot of standardization in that...

Finally, I worked with some great mid-levels in my last job (NP & PA) and they were great providers. They also knew the limits to their scope of practice just as I will when I graduate. I will not go around comparing myself to a neurosurgeon (hopeful EM doc)....

 

[schutzhund]

First off, get your head out of your ass (excuse my language and forward attitude). "...seen by some nurse?..." -- This "some nurse" is a nurse practitioner whom probably knows JUST AS MUCH as a primary care doc. If you don't think so, then you have some research to do. Most NP's I run into are far more advanced (knowledge wise) than a doctor. Most NP's have years of experience as an RN, and because of that, their observation skills are usually much more keen; therefore, as a NP in any sort of environment, they usually do much better than a doctor. You mention that you have seen doctors get sued "when things screw up." Do you have any credible research that proves that NP's cause a higher % of lawsuites for their attending MD/DO? I HIGHLY DOUBT IT. Excuse my explosive attitude, but it angers me when doctors stick on their high horse and pretend to be know it all's. Perhaps you should stop and pay attention to what the nurses do for you. If it weren't for the nurses, you would be nothing.

To the original poster - I think being the attending over NP's would be an awesome experience (very educational as well). You will probably soon find out how awesome it is to work with NP's. Their attitudes and personalities tend to be bubbly and excited to work. Their isn't a huge malpractice risk, as the other poster suggested.

This is some of the most ridiculous BS I've ever read on SDN (and that's pretty bad)!!!!!!!

Do you honestly believe that NPs 'know JUST AS MUCH as a primary care doc' or 'Most NP's I run into are far more advanced (knowledge wise) than a doctor'? If so, you are SORELY mistaken and completely and utterly wrong. It's also insulting.

As a nurse who went to medical school, I too can tell you firsthand that there is a HUGE difference in education. Huge. Not really even comparable. You can argue with me all you want but unless you've been there too it's just speculation and wrong. I probably learned more in medical school in one quarter as I did in nursing school. NP classes are more intense but they are still not even close to as in depth (or breath) as med school.

Delusional.

Having said all that, I have seen and worked with NPs that were knowledgeable and functioned well in their position and I think they have a role in healthcare. But they are NOT interchangeable with physicians.

To the OP, I would not have an issue supervising NPs if I had direct contact with them (i.e. presenting every pt to you in a fast tract scenario). As for serving as a "chart signer" only, I'd pass. Too much liability. I do not think NPs should serve with this type of autonomy and independence. It's only a matter of time before you get burned.

Would you sign off and take responsibility for a brand new FP intern operating their own clinic with only a 10% chart review? They have way more training than an NP. Think about it.

 

[oldManDO2009]

Would you sign off and take responsibility for a brand new FP intern operating their own clinic with only a 10% chart review? They have way more training than an NP. Think about it.

great point

 

[prairiedog]

This is some of the most ridiculous BS I've ever read on SDN (and that's pretty bad)!!!!!!!

As a nurse who went to medical school, I too can tell you firsthand that there is a HUGE difference in education. Huge. Not really even comparable. You can argue with me all you want but unless you've been there too it's just speculation and wrong. I probably learned more in medical school in one quarter as I did in nursing school. NP classes are more intense but they are still not even close to as in depth (or breath) as med school.

I wonder if really went to nursing school? Equating one quarter of medical school to 2-3 years of nursing school? You made some reasonable statements, but after reading how you learned more in one quarter you destroyed all of your Credibility

 

[FoughtFyr]

I wonder if really went to nursing school? Equating one quarter of medical school to 2-3 years of nursing school? You made some reasonable statements, but after reading how you learned more in one quarter you destroyed all of your Credibility

Actually, I did three years of a BSN before transferring to a different program. And I have also gone to medical school. I second what Schutzhund said. And unless you too have done both, you have no credibility to destroy prairiedog.

- H

 

[jesse14]

Actually, I did three years of a BSN before transferring to a different program. And I have also gone to medical school. I second what Schutzhund said. And unless you too have done both, you have no credibility to destroy prairiedog.

- H

FF, you must be the most educated and experienced person i have ever come in to contact with. From memory, you became a firefighter and then a paramedic, you have a Bachelor of health studies degree (i'm not sure that's what it's called) , a MPH, and an MD.. oh yeah, you also did 3 years of a nursing degree. My, you have had quite the academic journy.

 

[jesse14]

FF, you must be the most educated and experienced person i have ever come in to contact with. From memory, you became a firefighter and then a paramedic, you have a Bachelor of health studies degree (i'm not sure that's what it's called) , a MPH, and an MD.. oh yeah, you also did 3 years of a nursing degree. My, you have had quite the academic journy.

By the way FF, i just read your study of the EMS responce during the Columbine high school shootings. Very intersting stuff!!

 

[FoughtFyr]

FF, you must be the most educated and experienced person i have ever come in to contact with. From memory, you became a firefighter and then a paramedic, you have a Bachelor of health studies degree (i'm not sure that's what it's called) , a MPH, and an MD.. oh yeah, you also did 3 years of a nursing degree. My, you have had quite the academic journy.

Yep. I'm an old fart. Started off in nursing school (BSN) while working as a firefighter/paramedic. Hated it. Transferred into a Bachelor's program in Health Policy (they accepted alot of the nursing courses as "health background" courses needed for the degree) after three years; it took an additional two and a half years to finish. I went on to an MPH afterward. Worked for a year an a half for the Federal Government via a consulting firm, and then off to medical school. Now, I'm almost done with residency but looking forward to a fellowship (although Mrs. Foughtfyr may end up putting her foot down and make me get a real job). And all that says nothing of my paramedic training or the fire academy. So yep, I guess I have done a lot. My wife has been teasing me that this is the year when I have spent more time in school after high school graduation than I did before it. See why I get a bit riled when folks try to equate chiro training with an MD education?

- H

 

[Squad51]

FF, you must be the most educated and experienced person i have ever come in to contact with. From memory, you became a firefighter and then a paramedic, you have a Bachelor of health studies degree (i'm not sure that's what it's called) , a MPH, and an MD.. oh yeah, you also did 3 years of a nursing degree. My, you have had quite the academic journy.

Oops. Jesse, if you are going to call someone out, you should probably be pretty sure they aren't what they claim to be. I think FF probably has the experience he claims.

 

[jesse14]

Oops. Jesse, if you are going to call someone out, you should probably be pretty sure they aren't what they claim to be. I think FF probably has the experience he claims.

I by no means was "calling him out". I was just stating my amazment in his numerous credentials. I believe everything he said in his little biography he posted. He's a well educated individual. Why do you assume the worst of me squad? My intentions are pure and i have not hidded agenda. You accuse me of bigging up chiro and degrading medicine... please tell me in ANY post where i have done that?

As for FF. Let me see if i get this straight. You did pre-service, got on with a firefighting division and simultaneously did an undergrad degree? That's a hell of a lot to handle. I have friends (yes i know i'm only 21 and don't know much) who did the firefighting school and could not land a job due to the competition agonst people looking to get hired as firefighters. THis is by no means meant to be sarcastic at all. I just realy admire people who do so much in their life... it's awesome. So ff, you're almost done at Mayo eh? That's awesome. Best of luck!

 

[FoughtFyr]

As for FF. Let me see if i get this straight. You did pre-service, got on with a firefighting division and simultaneously did an undergrad degree? That's a hell of a lot to handle. I have friends (yes i know i'm only 21 and don't know much) who did the firefighting school and could not land a job due to the competition agonst people looking to get hired as firefighters. THis is by no means meant to be sarcastic at all. I just realy admire people who do so much in their life... it's awesome. So ff, you're almost done at Mayo eh? That's awesome. Best of luck!

Umm, I'm not Canadian, so I'm not sure what "pre-service" is. Where I grew up, almost all 911 ambulance service was provided under the "cross-trained / dual role" model by fire departments. That is, municipal firefighters trained as both firefighters and paramedics. So I took a paramedic class, aced it, and was hired by a fire department, then sent to the fire academy. After starting on the department (with a 24 hours on / 48 hours off schedule) I began undergrad classes, which would end 5.5 years later (after two majors). Then I went on for an MPH (by this time an officer on the department, so scheduling was a bit easier as the degree was viewed as "career advancement"). Then I quit for the government post. Then I went to medical school, and picked up shifts on another department for two years, finally hanging up the helmet in 2002. I don't see it as "too much to handle", it was what I did. I've always taken the view of Lazarus Long: "Always listen to experts. They'll tell you what can't be done, and why. Then do it." Seems to have worked for me.

- H

 

[oldManDO2009]

Yep. I'm an old fart. Started off in nursing school (BSN) while working as a firefighter/paramedic. Hated it. Transferred into a Bachelor's program in Health Policy (they accepted alot of the nursing courses as "health background" courses needed for the degree) after three years; it took an additional two and a half years to finish. I went on to an MPH afterward. Worked for a year an a half for the Federal Government via a consulting firm, and then off to medical school. Now, I'm almost done with residency but looking forward to a fellowship (although Mrs. Foughtfyr may end up putting her foot down and make me get a real job). And all that says nothing of my paramedic training or the fire academy. So yep, I guess I have done a lot. My wife has been teasing me that this is the year when I have spent more time in school after high school graduation than I did before it. See why I get a bit riled when folks try to equate chiro training with an MD education?

- H

I am in the same boat - man I am old....

 

[prairiedog]

Actually, I did three years of a BSN before transferring to a different program. And I have also gone to medical school. I second what Schutzhund said. And unless you too have done both, you have no credibility to destroy prairiedog.

- H

Why would I need to do both to disagree?
My understanding of the first 3 years of a BSN would include 2 years of generals (english, A&P, chem, micro, soc .....) , and one year of nursing education. Under the quarter system for the BSN you completed 9 quarters of education (3 years) that was less educational than ONE quarter of medical school? Maybe I am wrong, I still believe taking 3 years of college nursing education results in more "knowledge" as compared to one quarter of medical school.

 

[PublicHealth]

Why would I need to do both to disagree?
My understanding of the first 3 years of a BSN would include 2 years of generals (english, A&P, chem, micro, soc .....) , and one year of nursing education. Under the quarter system for the BSN you completed 9 quarters of education (3 years) that was less educational than ONE quarter of medical school? Maybe I am wrong, I still believe taking 3 years of college nursing education results in more "knowledge" as compared to one quarter of medical school.

Aren't there programs where you can get a "diploma" and R.N. license in less than a year if you have a bachelor's degree in a non-nursing discipline? Here's an example: http://www.bhson.com/programs/diploma/courses.cfm

Judging by the actual courses, the rigor of such programs pales in comparison to one WEEK of medical school!

 

[Happy613]

Why would I need to do both to disagree?
My understanding of the first 3 years of a BSN would include 2 years of generals (english, A&P, chem, micro, soc .....) , and one year of nursing education. Under the quarter system for the BSN you completed 9 quarters of education (3 years) that was less educational than ONE quarter of medical school? Maybe I am wrong, I still believe taking 3 years of college nursing education results in more "knowledge" as compared to one quarter of medical school.

The point is that one semester of medical school, especially in the first two years, requires you to assimilate a huge amount of information. As well you are required to already know a vast amount. The point is that most 1st year medical students, especially those with a science background, already having a bachelors will know a large amount of what would be taught in those 3 years you are alluding to.

For instance in my first semester, I had to learn all of anatomy, medical biochemistry, and medical genetics. Thats tens of thousands of facts, based on an already substantial pre-med foundation.

 

[prairiedog]

The point is that one semester of medical school, especially in the first two years, requires you to assimilate a huge amount of information. As well you are required to already know a vast amount. The point is that most 1st year medical students, especially those with a science background, already having a bachelors will know a large amount of what would be taught in those 3 years you are alluding to.

For instance in my first semester, I had to learn all of anatomy, medical biochemistry, and medical genetics. Thats tens of thousands of facts, based on an already substantial pre-med foundation.

I agree, I am not downplaying the level of intensity. One "quarter" or 10 weeks of medical school is far more significant than a "quarter" of undergraduate education. My tenet is 10 weeks of medical school is not equal to 90 weeks of undergraduate education. Maybe my undergraduate education was different? Maybe the University I attended was more difficult than others? My graduate courses were significantly more difficult than any single course I took as an undergraduate. But, did I learn more in 10 weeks (one quarter) as compared to 3 years (90 weeks)? My study habits were the same in both undergraduate and graduate school. I learned more over the three years (total knowledge) as compared to one quarter (10 weeks). I would like to see the study to support 10 weeks over 3 years. Although difficult to design and implement, my hypothesis would clearly support increased level of knowledge in the three year cohort.

 

[megsMS]

I 100% agree that your 3 years would not equal "10 weeks" of medical school if your 3 years was in nursing.

I agree, I am not downplaying the level of intensity. One "quarter" or 10 weeks of medical school is far more significant than a "quarter" of undergraduate education. My tenet is 10 weeks of medical school is not equal to 90 weeks of undergraduate education. Maybe my undergraduate education was different? Maybe the University I attended was more difficult than others? My graduate courses were significantly more difficult than any single course I took as an undergraduate. But, did I learn more in 10 weeks (one quarter) as compared to 3 years (90 weeks)? My study habits were the same in both undergraduate and graduate school. I learned more over the three years (total knowledge) as compared to one quarter (10 weeks). I would like to see the study to support 10 weeks over 3 years. Although difficult to design and implement, my hypothesis would clearly support increased level of knowledge in the three year cohort.

 

[oldManDO2009]

I agree, I am not downplaying the level of intensity. One "quarter" or 10 weeks of medical school is far more significant than a "quarter" of undergraduate education. My tenet is 10 weeks of medical school is not equal to 90 weeks of undergraduate education. Maybe my undergraduate education was different? Maybe the University I attended was more difficult than others? My graduate courses were significantly more difficult than any single course I took as an undergraduate. But, did I learn more in 10 weeks (one quarter) as compared to 3 years (90 weeks)? My study habits were the same in both undergraduate and graduate school. I learned more over the three years (total knowledge) as compared to one quarter (10 weeks). I would like to see the study to support 10 weeks over 3 years. Although difficult to design and implement, my hypothesis would clearly support increased level of knowledge in the three year cohort.

if you want to look at it in that perspective, since you have to have an undergraduate degree to even attend medical school then 10 weeks of GRADUATE educate does exceed 3 years of undergraduate education. But I think you are missing the point. You cannot compare nursing school courses to medical school - med school is much more intense and requires the assimilation of huge amounts of facts. This just does not happen in nursing school to the same degree of intensity. If you are still not convinced then go take a practice test for the USMLE step 2 (and don't peak at the answers) and compare this to the NCLEX (which I have sat for) and you should understand the difference.

 

[prairiedog]

if you want to look at it in that perspective, since you have to have an undergraduate degree to even attend medical school then 10 weeks of GRADUATE educate does exceed 3 years of undergraduate education. But I think you are missing the point. You cannot compare nursing school courses to medical school - med school is much more intense and requires the assimilation of huge amounts of facts. This just does not happen in nursing school to the same degree of intensity. If you are still not convinced then go take a practice test for the USMLE step 2 (and don't peak at the answers) and compare this to the NCLEX (which I have sat for) and you should understand the difference.

I think you have to have an undergraduate degree to enter most graduate programs. I have not been comparing content or intensity, rather total knowledge attained over a period of time. DO you think if an individual without 3 years of undergraduate education would learn more in the 10 weeks of medical school as compared to the person with 3 years of undergraduate education? Is one quarter of medical school the most difficult endeavor for any graduate student? Why not add the GRE or the LSAT or even the ACT as comparison outcome measures? Outcome measures indicate a baseline of knowledge or some would say guesses. Why do you think medical schools use more than paper tests to evaluate outcomes. The students have to be able to apply the knowledge to a patient. When comparing knowledge, 3 years of University courses should result in greater overall attainment of knowledge as compared to 10 weeks of medical school. Nursing education incorporates clinical experiences through out the educational process, the chance to apply what they are learning over a 3 year period. Using personal observations to suggest one 10 week quarter is better than 3 years is not scientific and clearly not measurable. Can I say a PA is smarter than a MD based on my personal experience? I know of several PAs who are far more competent than several MDs. Does this mean they are smarter? That they learned more in 2 years than MDs did in 6-8 years. Experiences are great, they don’t always tell the whole story.
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[Dr.MISHKA D.O.]

man this post has really strayed. I just want to know if accepting the responsibility of being over several NP's is worth it financially. i.e. what percentage do I get of what they earn, etc. Any help appreciated.

 

[oldManDO2009]

Ya we took a left turn a while ago....I think that it would depend on the medico-legal situation. If you are responsible for the care of all patients seen by the NP I would be worried since you would have little oversight (just a time thing) of the care provided. If the NP is responsible (base on the opinion of the hospital legal department) and carries sufficient malpractice then it may be doable. Will you be paid for these extra responsibilities?

MDA's that supervise CRNAs get paid a fee by Medicare - so there is a huge financial incentive to supervise up to 4 CRNAs (as I undererstand it). I am not sure if happens on the NP side....

As for the left turn...the depth of patho-physiology taught in nursing school does not even compare to medical school. So this comparison of years of college is pretty pointless. A nurse will learn basic diseases of the heart and medical school will delve deep into the cause of disease and the "molecular" origin e.g. coagulative necrosis or pathology of infarction....

Having attended nursing school – I have a much better understanding of pathology not even covered in nursing school. We have spent a great deal of time learning types of inflammation, complement activation, immune response, and tissue slides with the various types of inflammation. This is far more comprehensive then the standard undergraduate patho-physiology course for nurses.

 

[zenman]

man this post has really strayed. I just want to know if accepting the responsibility of being over several NP's is worth it financially. i.e. what percentage do I get of what they earn, etc. Any help appreciated.

Let me give you a hint about who to talk to...the hospital administrators. They should be able to tell you how much you will be making, the hours involved, etc.. Then you make a decision about whether it will be worth it to you.

 

[prairiedog]

man this post has really strayed. I just want to know if accepting the responsibility of being over several NP's is worth it financially. i.e. what percentage do I get of what they earn, etc. Any help appreciated.

Depends on the state and institution, most states do not require you be "over" a NP and often no responsibility. You are collaborating most often for the purpose of prescribing medications. The NP is covered by their own malpractice not yours, unless of course both of you saw the patient.
I have seen as little as $500 a month given to the MD who collaborates with the NP. On the other hand, the NP may only collaborate once a month depending on the practice. The worth is in the provider, if you are working with a known entity, should be easy money. If you are looking to collaborate with any NP just for the purpose of increased $$$, I wouldn't find the opportunity appealing.

On the left turn--Ignorance prevails

 

[deleted6669]

man this post has really strayed. I just want to know if accepting the responsibility of being over several NP's is worth it financially. i.e. what percentage do I get of what they earn, etc. Any help appreciated.

can't speak to $$$ for supervising np's but I have 3 friends who are pa's who opened a same day ambulatory/urgent clinic in an area with no other clinic. they hired a doc to review their charts and purchased him his own malpractice policy for extra coverage although he does not see pts at all. he carries a cell phone and pager whenever the clinic is open for phone consults. they refer out all gyn and subspecialty im pts. they take only cash or medicare/medicaid.the docs cut is 3000/month. each pa makes 150k/yr after expenses working 2 12 hr shifts/week....they have minimal overhead because their clinic is an old warehouse and they bought all of their exam room equipment used. their entire staff is 1 medical assistant who has a limited xray license to use their korean war era xray machine......

 

[Baylee]

I know that PA's have to have their collaborating physician review something like 10% of the charts; however if a malpractice claim is brought by a patient against a PA, and it was not on one of those "10% reviewed" is the MD/DO still liable?

The MD is always liable when the PA screws up. I'm not sure about the NP's, it probably depends on state laws.

I have a friend in primary care and he has a nurse practitioner working for him. He's loving it, because he works a lot less and is making good $$$. I believe he pays her around 85K a year plus benefits. Last year was her second year and she paid for herself in less than TWO MONTHS! He said all the patients love her and a lot of them would rather see her than him. He doesn't mind at all, he's got fishing and golfing on his mind! He's only 42 years old and it's almost like he's already retired.

 

[Baylee]

can't speak to $$$ for supervising np's but I have 3 friends who are pa's who opened a same day ambulatory/urgent clinic in an area with no other clinic. they hired a doc to review their charts and purchased him his own malpractice policy for extra coverage although he does not see pts at all. he carries a cell phone and pager whenever the clinic is open for phone consults. they refer out all gyn and subspecialty im pts. they take only cash or medicare/medicaid.the docs cut is 3000/month. each pa makes 150k/yr after expenses working 2 12 hr shifts/week....they have minimal overhead because their clinic is an old warehouse and they bought all of their exam room equipment used. their entire staff is 1 medical assistant who has a limited xray license to use their korean war era xray machine......

If I was the doc, then I would definitely want a bigger cut of that action. I find it very hard to believe that they are clearing 150K working 2 days per week. I have friends in primary care who aren't coming close to that!

 

[Baylee]

man this post has really strayed. I just want to know if accepting the responsibility of being over several NP's is worth it financially. i.e. what percentage do I get of what they earn, etc. Any help appreciated.

I believe the going rate is 10% of what they collect.

 

[deleted6669]

If I was the doc, then I would definitely want a bigger cut of that action. I find it very hard to believe that they are clearing 150K working 2 days per week. I have friends in primary care who aren't coming close to that!

it's their practice ...if he wants more they fire him and replace him with someone who works cheap...it's not like the guy actually does anything except rubber stamp a few charts.....they always have a back up doc on board in case 1 dies or quits, etc

 

[chimichanga]

You're going to sign your name to chart on a patient (who you never saw) seen by some nurse? I 've seen docs get sued when things get screwed up.
I wouldn't stick my neck out for that crap.

Nice attitude...Get over yourself

 

[Faebinder]

Despite all the rudeness that some of my colleagues utilized to reply to this thread... I will say that I agree...

If I am going to be held at least liable for the NP/PA then I want a cut... it's a risk vs benefit. Taking 'extra' risk should give me 'extra' benefit. Even if the average NP/PA is equivilant risk wise to the MD/DO, I still am now gaining a significant additional risk (your name can be mentioned in the lawsuit) and therefore I would want a significant additional compensation.

 

[chimichanga]

If I am going to be held at least liable for the NP/PA then I want a cut... it's a risk vs benefit. Taking 'extra' risk should give me 'extra' benefit. Even if the average NP/PA is equivilant risk wise to the MD/DO, I still am now gaining a significant additional risk (your name can be mentioned in the lawsuit) and therefore I would want a significant additional compensation.

That's a no brainer...

In AZ, NPs AND PAs can see pts in urgent cares, offices, and ERs without a doc examining the patient...But the PA is supervised (on paper) by the doc, so there is liability there...The NP is on her own...

 

[Beau Geste]

This is not an MD/DO vs. NP/PA thread.

Keep the comments on topic, and please be respectful of other posters' professions.

 

[core0]

That's a no brainer...

In AZ, NPs AND PAs can see pts in urgent cares, offices, and ERs without a doc examining the patient...But the PA is supervised (on paper) by the doc, so there is liability there...The NP is on her own...

Actually there is still significant liability for NP's in the ER situation. The ER attending will usually be roped back in for NP's. Depends on the state, but for inpatient settings, there is usually liability of either the attending or the medical director.

Most other states require either collaboration or supervision for NP's. Supervision makes it similar to liability for PA's. Collaboration depends on the state and the amount necessary. In some states there is a requirement to have a collaborating physician for referral for complex problems. In this case the liability would be on the NP for failure to refer and no liability to the physician unless they got involved (told the NP not to refer or refused the referral). In other states collaboration agreements spell out the scope of practice and what the NP can do. Here there is liability for omissions in the scope of practice or giving permission for them to do something that ultimately goes wrong (you gave the NP permission to treat strep throat, how did you confirm they could tell it wasn't meningitis - etc).

In summary you really have to know what you are getting into. I would talk to a lawyer who is very familar with oversight rules for your state.

David Carpenter, PA-C

 

[deleted6669]

That's a no brainer...

In AZ, NPs AND PAs can see pts in urgent cares, offices, and ERs without a doc examining the patient...But the PA is supervised (on paper) by the doc, so there is liability there...The NP is on her own...

actually this is true in most states. some states require a physician be on site for questions, most do not.
pa's in many states run solo rural practices with their supervising physician available by phone only.